Provider Demographics
NPI:1477723062
Name:DAVIS, EBONIEMARIE ALLENE (RN)
Entity type:Individual
Prefix:MRS
First Name:EBONIEMARIE
Middle Name:ALLENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EBONIEMARIE
Other - Middle Name:ALLENE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4019 E 121ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4552
Mailing Address - Country:US
Mailing Address - Phone:216-246-4881
Mailing Address - Fax:
Practice Address - Street 1:4019 E 121ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4552
Practice Address - Country:US
Practice Address - Phone:216-246-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 126718164W00000X
OHRN.543471163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse